1114237740 NPI number — KRISTIE DIANE BAKER MS, LMFT

Table of content: KRISTIE DIANE BAKER MS, LMFT (NPI 1114237740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114237740 NPI number — KRISTIE DIANE BAKER MS, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
KRISTIE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKER
Provider Other First Name:
KRISTIE
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LMFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114237740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 MOUNT ROSE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-835-1594
Provider Business Mailing Address Fax Number:
775-201-4932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 MOUNT ROSE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-3352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-835-1594
Provider Business Practice Location Address Fax Number:
775-201-4932
Provider Enumeration Date:
10/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1201 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)